1 of 27 Board Integrated Performance Report - February 2018
1.2 NHS Improvement
Segment
Board Integrated Performance Report
22 February 2018
January 2018 Data
Requires
Improvement
1.1 CQC Rating 1.3 NHS Improvement
Use of Resources
1
Agenda item: 12
Lead Director: Director of Finance,
Contracting and Facilities
Presented for: Assurance
1
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
2 of 27 Board Integrated Performance Report - February 2018
The purpose of this Integrated Performance Report is to assist the Board in assessing the Trust’s performance and progress in
delivery of a broad range of key targets and indicators.
Board Action Key Highlights Slides
NHS Improvement Indicators
Information
Exceptions
• The Care Quality Commission (CQC) rating reflects the CQC report published in February 2018, following the 2017
inspection. The Board is receiving a separate paper on the CQC inspection results.
• In January 2018, we have not met the waiting time target for people with a first episode of psychosis. The
underlying reasons, actions being taken and forecast quarter 4 performance will be considered at the business unit
performance meeting and a verbal update provided to Board.
• As forecast, the Improving Access to Psychological Therapy (IAPT) recovery rate for quarter 3 remains slightly
below the 50% target. The identified actions are impacting positively, with local data for January 2018 indicating
recovery rates above 50% across all three Clinical Commissioning Groups. Performance continues to be reviewed
monthly at the business unit performance meeting.
1
4
5
Quality
Exceptions
Information
• Information Governance training remains below target. Hotspot services are currently: community nursing services,
Bradford health visiting service, child & adolescent mental health service, adult community mental health teams,
acute mental health inpatient services and specialist inpatient services. A total of 295 records are showing as out of
date, however, deeper interrogation of the data shows that there will also be a further 305 records that will be out of
date by the end of March reducing the compliance rate to 75% for year end. A total of 514 training episodes will
need to be completed to achieve the 95% target by the end of March 2018.
• Sickness remains above target. Stress and anxiety remains the main reason for sickness absence and is 15%
higher than sickness absence related to musculo-skeletal. A new absence policy is being consulted upon and a
sickness absence toolkit is being rolled out to support managers tackle sickness absence in a supportive, but
robust manner. Short term sickness shows a seasonal trend meaning that if the current year follows this usual
pattern we should see sickness rates start to reduce in March.
• There was one duty of candour incident in January 2018. This relates to a palliative care patient who was
discharged from the district nursing service after several attempts at visiting the home address without success.
9 - 10
11 - 12
21
Business Unit
Information • The report has been produced in advance of the scheduled business unit performance meetings. The Board will
receive a verbal update regarding any additional issues identified for escalation.
Change Programme
Exceptions
• The 2017/18 Change Programme provides governance, monitoring and assurance for eight transformation projects
delivering significant service transformation and change. Of the eight projects:
- Four are rated red (roster savings; mental health acute and community; specialist inpatients, dental &
administration; procurement)
- One is rated amber (corporate benchmarking)
- Three are rated green (adult physical health; estates and facilities; children’s services).
22
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
3 of 27 Board Integrated Performance Report - February 2018
The purpose of this Integrated Performance Report is to assist the Board in assessing the Trust’s performance and progress in
delivery of a broad range of key targets and indictors.
Board Action Key Highlights Slides
Finance
Assurance
Exceptions
• Control Total Performance – 2017/18 Performance: Surplus/(Deficit) Position: With a year to date surplus
of £1,917k (excluding £410k adjustments relating to asset disposals) performance is £1,476k ahead of the
planned surplus of £441k. The surplus includes Sustainability and Transformation Funding (STF) of £577k.
The Trust experienced higher than average inpatient ward bank and agency costs in Month 9 and continued
into Month 10 relating to cover for sickness, vacancies and special observation costs. Key issues ta=hat are
impacting underlying Trust performance are inpatient staffing levels and disputed community property charges.
The latter have been escalated and NHSI is supporting actions to resolve. Subject to containment of these the
Trust forecasts meeting the 2017/18 Control Total of £826k surplus to secure access to £752k STF and deliver
a £1,578k composite surplus.
• Cash: Balances are £5.4m above plan reflecting favourable Control Total performance, receipt of 2016/17 STF,
asset disposal proceeds and supplemented by capital slippage. We project delivering an end of year cash
balance of £14.5m which is £3m ahead of plan. The £3m favourable movement includes 2016/17 STF cash
flows of £1.6m and receipts from a surplus asset disposal £0.8m, neither of which were assumed in the plan,
and working balance adjustments as a consequence of capital and revenue plan slippage.
• Use of Resources (UoR): The actual at Month 10 is ‘1’ which is the same as planned.
• CIPs: CIPs have under achieved by £121k YTD and are forecast to under achieve by £498k (before mitigation
by the £500k high risk CIP reserve). The recurrent CIP plan gap that will be carried into 2018/19 is £70k but this
requires management of inpatient pressures.
• Workforce – Agency Controls: Agency expenditure caps are being achieved for all but medical staffing. The
medical cap was exceeded by £30k in month and by £213k year to date. There were 207 price cap and 210
wage cap breaches at the end of January (5 week month) all related to medical locums. A number of wage and
price cap Agency reporting anomalies have been identified that will adjust (improve) reported performance.
• Capital: Capital expenditure to the end of January was £253k below plan, driven by under spending in both
IM&T and Estates. Some of this is a result of re-prioritising programmed expenditure to accommodate in-year
pressures. The programme remains fully committed.
23 - 26
Summary and Recommendations
The report has been produced in advance of the Directors’ Business & Transformation meeting. Correlation of quality (including patient
experience and safety related measures), performance, finance, workforce and health and safety information will take place at the meeting.
The Board will receive a verbal update of any themes or trends for escalation.
The Board is recommended to consider the exceptions highlighted and note the proposed actions.
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
4 of 27 Board Integrated Performance Report - February 2018
Single Oversight Framework Operational Performance Metrics
Indicator M7: Data is provided in relation to the waiting time element of the new standard for Early Intervention in Psychosis (EIP). This
shows patients who started treatment in January 2018 within two weeks of referral. The number of incomplete pathways (patients waiting) at
the end of January 2018 was 41; 30 of these patients have been waiting for more than two weeks.
Indicator M23: The Trust has relatively few inappropriate out of area bed days, relating to the Psychiatric Intensive Care Unit only. The
Trust’s local data for out of area bed days are included in the Board integrated performance report, rather than using the NHS Digital
published data that suppresses small numbers.
Measure
Target
England
Benchmarking
figure
Graph Key
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
80.0%
85.0%
90.0%
95.0%
100.0%
May16
Jun16
Jul16
Aug16
Sep16
Oct16
Nov16
Dec16
Jan17
Feb17
Mar17
Apr17
May17
90.0%
92.5%
95.0%
97.5%
100.0%
May16
Jun16
Jul16
Aug16
Sep16
Oct16
Nov16
Dec16
Jan17
Feb17
Mar17
Apr17
May17
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
May16
Jun16
Jul16
Aug16
Sep16
Oct16
Nov16
Dec16
Jan17
Feb17
Mar17
Apr17
May17
Q1 17/18 Q2 17/18 Q3 17/18 Q4 17/18 Q4 17/18 Q4 17/18
Outturn Outturn OutturnNumerator
Outturn
Denominator
OutturnOutturn
M3
Maximum time of 18 weeks from point of referral to
treatment (RTT) in aggregate − patients on an incomplete
pathway
92.0% 100.0% 409 409 100.0%88.2% as of Dec
17
M23
Inappropriate out of area placements for adult mental health
services – number of bed days patients have spent out of
area
10 17 178 20 20
M7
People with a first episode of psychosis begin treatment with
a NICE-recommended package of care within 2 weeks of
referral
50.0% 69.5% 78.0% 74.4% 38.4% 10 26 38.4%
Ensure that cardio-metabolic assessment and treatment for
people with psychosis is delivered routinely in the following
service areas:
a) Inpatient Wards 90.0% 98.0%
b) Early Intervention in psychosis services 90.0% 94.0%
c) Community mental health services (people on Care
Programme Approach)65.0% 96.0%
M19
Indicator
No.
Indicator
Target Jan Feb MarNational
BenchmarkGraph
80.0%
85.0%
90.0%
95.0%
100.0%
Jan17
Feb17
Mar17
Apr17
May17
Jun17
Jul17
Aug17
Sep17
Oct17
Nov17
Dec17
Jan18
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Jan17
Feb17
Mar17
Apr17
May17
Jun17
Jul17
Aug17
Sep17
Oct17
Nov17
Dec17
Jan18
5 of 27 Board Integrated Performance Report - February 2018
Indicator M21: Improving Access to Psychological Therapies (IAPT) recovery rate has reduced in all three Clinical Commissioning Group
(CCG) areas in quarter 2 and quarter 3. This is largely due to revisions in treatment pathways to reduce waiting times for psychological
therapy within Community Mental Health Teams (CMHT). We have developed a stepped care approach during this period which is based on
cluster. MyWellbeing College is a uni-disciplinary service appropriate to work with clusters 1 to 4 and not appropriate for people (clustered 5
to 17) who require a multi-disciplinary approach i.e. require psychological therapy within CMHT. We have ensured that people clustered 1 to
4 now receive therapy within MyWellbeing College, reducing demand on CMHT therapy. We have instigated an improved assessment and
triage process, this has optimised the flow into the two pathways ensuring as far as possible that clients are seen by the appropriate
service. We have also instigated a review process for those missed at initial assessment enabling them to be signposted to the appropriate
service without negatively impacting on recovery rates.
The Trust has commenced innovative work within the City IAPT Team to consider and develop appropriate service responses to cultural
issues. This work is supported by Hari Sewell, a national expert in the specialist field of equalities in mental health, and is due to complete
in June 2018. We expect that this will support improvements in both access and recovery in City CCG and also BME populations across the
district, by introducing culturally adapted promotion and interventions based on BME service user experience.
Local Trust data for January 2018 indicates recovery rates above 50% across all three CCGs. This indicates the
identified actions are impacting positively at the beginning of quarter 4.
Single Oversight Framework Operational Performance Metrics
Measure
Target
England
Benchmarking
figure
Graph Key
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
Q1 17/18 Q2 17/18 Q3 17/18 Q4 17/18 Q4 17/18 Q4 17/18
Outturn Outturn OutturnNumerator
Outturn
Denominator
OutturnOutturn
M22Data Quality Maturity Index (DQMI) mental health services
data set score 95.0% 97.8% 98.0%
Next publication
date:
TBC
M21Proportion of people completing treatment who move to
recovery (from IAPT minimum dataset)50.0% 54.9% 49.6%
48.4%
(Provisional)
48.4%
(Final)717 1384 51.8%
50.1% as of Oct 17:
Next publication date
22/02/18
M10
waiting time to begin treatment (from IAPT minimum data
set)
- within 6 weeks
75.0%96.4% 96.3%
96.1%
(Provisional)
96.1%
(Provisional)#N/A
45.2%
(Final)
88.3% as at
Oct 17
Next publication
date:
22/01/18
M11
waiting time to begin treatment (from IAPT minimum data
set)
- within 18 weeks
95.0%99.2% 99.6%
98.8%
(Provisional)
98.8%
(Provisional)#DIV/0! 45.2% ()
98.5% as at
Oct 17
Next publication
date:
22/02/18
National
BenchmarkGraph
Indicator
No.
Indicator
Target Jan Feb Mar
40.0%
45.0%
50.0%
55.0%
60.0%
Apr16
May16
Jun16
Jul16
Aug16
Sep16
Oct16
Nov16
Dec16
Jan17
Feb17
Mar17
Apr17
May17
Jun17
Jul17
Aug17
Sep17
Oct17
60.0%
70.0%
80.0%
90.0%
100.0%
Apr16
May16
Jun16
Jul16
Aug16
Sep16
Oct16
Nov16
Dec16
Jan17
Feb17
Mar17
Apr17
May17
Jun17
Jul17
Aug17
Sep17
Oct17
85.0%
87.5%
90.0%
92.5%
95.0%
97.5%
100.0%
Apr16
May16
Jun16
Jul16
Aug16
Sep16
Oct16
Nov16
Dec16
Jan17
Feb17
Mar17
Apr17
May17
Jun17
Jul17
Aug17
Sep17
Oct17
6 of 27 Board Integrated Performance Report - February 2018
Airedale NHS Foundation Trust and Bradford Teaching Hospitals NHS Foundation Trust performance against the national standard for
Accident and Emergency (A&E) waits is provided to the Board for information. The Trust contributes to delivery of the target through a range
of services and interventions. The Trust is working actively with both Airedale NHS Foundation Trust and Bradford Teaching Hospitals
Foundation Trust on providing support within A&E departments and developing pathways designed to avoid admissions.
NHS England and NHS Improvement planning guidance for 2018/19 outlines that the A&E performance recovery trajectory has been pushed
back one year, with aggregate performance against the standard expected at or above 90% by September 2018. The majority of providers
are expected to achieve the 95% standard in March 2019, with the NHS returning to 95% overall performance within 2019. The guidance
states that there will be no additional winter funding in 2018/19. Systems are required to produce a winter demand and capacity plan with
actions and proposed outcomes. Guidance on submitting these winter plans will be available by March 2018.
Accident and Emergency Waiting Times
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
Indicator
No. Indicator TargetQ4
16/17
Q1
17/78
Q2
17/78
Q3
17/78Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18
Total A&E attendances 15,053 16,506 16,533 16,841 5,124 4,765 4,723 4,852 4,585 5335 4,996 4,577 5,480 5,318 5,764 5,424 5,770 5,225 5,538 5,547 5,416 5,878 5,420
Total attendances within 4 hours 13,840 15,528 15,546 15,591 4,628 4,232 4,314 4,375 4,164 4641 4,416 4,323 5,101 4,960 5,403 5,165 5,519 4,868 5,159 5,221 5,029 5,341 5,017
M18a% of A&E attendances where service
user was admitted, transferred or
discharged within 4 hours
95% 91.9% 94.1% 94.0% 92.6% 90.3% 88.8% 91.3% 90.2% 90.8% 90.1% 88.4% 94.5% 93.1% 93.3% 93.7% 95.2% 95.6% 93.2% 93.2% 94.1% 92.9% 90.9% 92.6%
Total A&E attendances 34,435 32,411 34,084 40,255 11,926 10,849 11,070 11,514 11,184 11,737 11,080 9,969 11,362 11,105 12,000 10,979 11,808 10,879 12,241 13,723 13,050 13,482 11,278
Total attendances within 4 hours 28,941 29,091 28,031 33,865 10,714 9,774 9,762 9,792 9,516 9,633 9,612 8,981 10,498 9,709 9,825 8,497 10,405 9,611 10,809 11,591 11,088 11,186 8,819
M18b% of A&E attendances where service
user was admitted, transferred or
discharged within 4 hours
95% 84.0% 89.8% 82.2% 84.1% 89.8% 90.1% 88.2% 85.0% 85.1% 82.1% 86.8% 90.1% 92.4% 87.4% 81.9% 86.3% 88.1% 88.3% 88.3% 84.5% 85.0% 83.0% 78.2%
Airedale NHS Foundation Trust
Bradford Teaching Hospitals NHS Foundation Trust
7 of 27 Board Integrated Performance Report - February 2018
Serious Incident Numbers
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
This data is monitored in more detail via the Quality and Safety Committee (QSC) on a quarterly basis.
The “Serious Incident Other” in January 2018 relates to the death of a detained patient.
0
1
2
3
4
5
6
Jan - 17 Feb - 17 Mar - 17 Apr - 17 May - 17 Jun - 17 Jul - 17 Aug - 17 Sep - 17 Oct - 17 Nov - 17 Dec - 17 Jan - 18
Jan - 17 Feb - 17 Mar - 17 Apr - 17May -
17Jun - 17 Jul - 17 Aug - 17 Sep - 17 Oct - 17 Nov - 17 Dec - 17 Jan - 18
Suspected Suicides 1 2 0 1 2 1 0 1 1 0 2 0 1
Serious incidents Other 0 0 0 3 1 0 0 1 5 1 1 0 1
Indicator
No.
16/17
Out-turn
This month's
performance
17/18 Year
to Date
Q3 96 2 22
8 of 27 Board Integrated Performance Report - February 2018
Number of Compliments, Complaints and Claims
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
Indicator Q9: compliments are distributed amongst several service areas.
0
10
20
30
40
50
60
70
80
90
100
Jan - 17 Feb - 17 Mar - 17 Apr - 17 May - 17 Jun - 17 Jul - 17 Aug - 17 Sep - 17 Oct - 17 Nov - 17 Dec - 17 Jan - 18
Jan - 17 Feb - 17 Mar - 17 Apr - 17 May - 17 Jun - 17 Jul - 17 Aug - 17 Sep - 17 Oct - 17 Nov - 17 Dec - 17 Jan - 18
Complaints numbers 9 4 5 4 8 8 5 6 4 7 4 5 7
Compliments numbers 54 48 26 37 37 34 92 49 57 70 56 56 25
` Indicator 16/17
outturn This Month
17/18
YTD
Q6 Claims Numbers 15 0 10
Q8 Complaints numbers 78 7 58
Q9 Compliments numbers 529 25 513
9 of 27 Board Integrated Performance Report - February 2018
Workforce – Appraisal and Mandatory Training
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
Measure
Target
Trend
Graph Key
Indicator
No. Indicator
16/17
outturn
17/18
Target Numerator Denominator
Current
Performance
FOT
17/18 Graph
Q17
% Mandatory training
(excl. Information
Governance
Compliance)
88.96% 80.00% 7275 8214 88.57%
Q17a
% Information
Governance Training
- Substantive Staff
Only
98.46% 95.00% 2314 2536 91.25%
Q17b % Information
Governance Training
- Tertiary Staff Only
96.51% 95.00% 341 365 93.42%
Q17c
% Information
Governance Training
- Substantive and
Tertiary Staff
Combined
98.28% 95.00% 2655 2901 91.52%
Q18 % Staff Receiving
Appraisal 83.77% 80.00% 2044 2522 81.05%
70.0%
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
Feb-17
Mar-17
Apr-17
May-17
Jun-17
Jul-17
Aug-17
Sep-17
Oct-17
Nov-17
Dec-17
Jan-18
80.00%
85.00%
90.00%
95.00%
100.00%
Feb-17
Mar-17
Apr-17
May-17
Jun-17
Jul-17
Aug-17
Sep-17
Oct-17
Nov-17
Dec-17
Jan-18
80.0%
85.0%
90.0%
95.0%
100.0%
Feb-17
Mar-17
Apr-17
May-17
Jun-17
Jul-17
Aug-17
Sep-17
Oct-17
Nov-17
Dec-17
Jan-18
80.0%
85.0%
90.0%
95.0%
100.0%
Feb-17
Mar-17
Apr-17
May-17
Jun-17
Jul-17
Aug-17
Sep-17
Oct-17
Nov-17
Dec-17
Jan-18
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
Feb-17
Mar-17
Apr-17
May-17
Jun-17
Jul-17
Aug-17
Sep-17
Oct-17
Nov-17
Dec-17
Jan-18
10 of 27 Board Integrated Performance Report - February 2018
Workforce – Appraisal and Mandatory Training
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
The overall Mandatory Training compliance currently stands at 88.28%, which is a 3.2% increase across the quarter (November 2017 –
January 2018). The hotspot areas (i.e. the 3 Business Units with the lowest current compliance) are:
• Mental Health – Acute Inpatient and Community Services (86.85%)
• Trust Management (88.49%)
• Adult Physical Health Community Services (89.59%)
All 12 Business Units are achieving the 80% target. 6 Business Units report an increase in compliance since December 2017.
For Information Governance training, Trust compliance has reduced across the quarter by 1.8% for substantive only staff and by 0.8% for
substantive and tertiary staff combined. Therefore despite additional management focus compliance remains below the 95% target. The
hotspot areas (substantive only) are:
• Medical (60.00%) – this relates to 3 out of 5 members of staff being in date.
• Wakefield Children’s Services (86.05%)
• Mental Health – Acute Inpatient and Community Services (89.26%)
Just 3 of the 12 Business Units are achieving the 95% target. 6 Business Units report an increase in compliance since December 2017.
Appraisal compliance has reduced by 2.6% across the quarter. The hotspot areas are:
• Mental Health – Acute Inpatient and Community Services (76.90%)
• Adult Physical Health Community Services (77.34%)
9 of the 12 Business Units are achieving the 80% target. 2 Business Units report an increase in compliance since December 2017.
Actions to address performance:
• Directors have contacted team leaders of staff members who are out of date with information governance training, indicating the
importance of action to ensure staff whose training has lapsed are brought back in date and take action to ensure that those whose
training is due to lapse do not go out of date.
• Training in Business Intelligence reporting from ESR continues to be rolled out to managers to enable running of ‘real time’ information to
be used for operational performance monitoring. Standard reports are being developed that managers will be able to use within Business
Intelligence that will match the parameters used within the main workforce key performance indicators reported to Board.
• In conjunction with the training, trajectory reports are being developed at service level to inform the senior managers on numbers of staff
going out of date and the required number of staff per month to achieve target within their area, to assist with forward planning to achieve
target (as well as future stretch targets) and will be available from the start of the new financial year.
• Following the TUPE transfer of Wakefield staff into the Trust, an action plan has been developed and is being monitored to ensure staff
are compliant with key workforce indicators.
11 of 27 Board Integrated Performance Report - February 2018
Workforce – Labour Turnover, Vacancy and Absence
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
Measure Long term sickness threshold (2.5%) Long term sickness
Target Short term sickness threshold (1.5%) Short term sickness
Trend
Graph Key
Indicator
No. Indicator
16/17
outturn
17/18
Target
Current
Performance
FOT
17/18 Graph
Q19 % Labour Turnover 13.04% 10.0% 11.16%
Q20 % Sickness absence rate 5.12% 4.0% 5.96%
Q21
% Vacancy rate (Budgeted WTE less staff in post
WTE as a percentage of
budgeted WTE)
7.17% 10.0% 9.19%
Q21
% Recruitment rate (Number of posts being actively
recruited to as a percentage of
staff in post)
10.0% 9.41%
8.00%
9.00%
10.00%
11.00%
12.00%
13.00%
14.00%
Feb-17
Mar-17
Apr-17
May-17
Jun-17
Jul-17
Aug-17
Sep-17
Oct-17
Nov-17
Dec-17
Jan-18
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
7.00%
Feb-17
Mar-17
Apr-17
May-17
Jun-17
Jul-17
Aug-17
Sep-17
Oct-17
Nov-17
Dec-17
Jan-18
4.00%
6.00%
8.00%
10.00%
12.00%
Feb-17
Mar-17
Apr-17
May-17
Jun-17
Jul-17
Aug-17
Sep-17
Oct-17
Nov-17
Dec-17
Jan-18
12 of 27 Board Integrated Performance Report - February 2018
Workforce – Labour Turnover, Vacancy and Absence
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
Labour Turnover has increased by 0.2% across the quarter, currently reflecting 287.15 WTE leavers across the last 12 months. The
hotspot areas are:
• Specialist Services & Nursing (19.13%)
• Adult Physical Health Community Services (14.22%)
• Human Resources (13.31%)
Retirements account for 19.35% of all leavers, whilst a further 16.40% are due to voluntary resignation – other/not known. 40.02% of
leavers are qualified nurses, 29.34% of those were through retirement, and 67.44% were through voluntary resignation. 19.54% of all
leavers left with less than one years service.
Actions to address:
• Reviewing how information is collected to gather intelligence on reasons for leaving to inform retention strategies as part of the national
recruitment and retention project;
• Proactive work continuing with universities to recruit newly qualified nurses and review of the preceptorship programme;
• As part of the Trust involvement in the NHS Improvement 90 Day Rapid Improvement Programmes; retention plans are currently being
developed. These include a staff development programme, exploring how flexible working options can be further extended, and skill
mixing to provide additional career opportunities for nurses.
• A number of recruitment days have been held to promote roles and working for the Trust;
• Recruitment and selection processes are being reviewed to ensure they are as streamlined as possible.
• A Strategic Recruitment Plan is being developed for 2018/19 specifically for qualified nursing and healthcare support worker roles.
Sickness Absence rates have increased by 0.23% across the quarter, standing at 5.96% for January 2018, 5.55% YTD, currently
exceeding the 4% target. The hotspot areas are:
• Estates, Facilities & Finance (8.43%, 4.66% long term – 17 ongoing long term sickness cases);
• Specialist Inpatient Services, Dentistry & Administration (7.91%, 4.02% long term – 21 ongoing long term sickness cases).
• Adult Physical Health Community Services (6.65%, 4.29% long term – 33 ongoing long term sickness cases);
The primary cause of long term sickness within these hotspot areas are stress and musculoskeletal, the primary cause of short term
sickness is cold/flu and gastrointestinal.
Actions to address:
• The absence management policy has been developed and is due to go to Staff Side for consultation.
• Work is underway to promote the absence management toolkit for managers to help them provide proactive support to staff.
Vacancy rate - The current vacancy rate stands at 9.19% equating to approximately 260.39 vacant WTE, with a recruitment rate of 9.41%.
Actions to address:
• Although reduction in vacancy rate is a positive sign that posts are successfully being recruited to; a review of skill mix and service
redesign may benefit from some vacancy within the service. This is currently being discussed as part of the safer staffing ward reviews
being conducted within Inpatient services.
13 of 27 Board Integrated Performance Report - February 2018
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
Workforce – Agency Reporting – as at December 2017
Annual
Budget
£000's
Funded
WTE
In month
cost x 12
£000's
In month
WTE
Annual
Cost per
WTE
£000's
In month
Change
In month
cost x 12
£000's
In
month
WTE
Annual
Cost per
WTE
£000's
In month
Change
In month
cost x 12
£000's
In month
WTE
Annual
Cost per
WTE
£000's
In month
Change
In month
cost x 12
£000's
In month
WTE
Annual
Cost per
WTE
£000's
In month
Change
Consultants 5,576 43.21 4,913 38.63 £127 0 0.00 1,106 6.53 £169 6,019 45.16 £133
Career/Staff Grades 3,187 44.85 2,884 33.23 £87 0 0.00 0 0.00 2,884 33.23 £87
Trainee Grades 995 14.70 349 5.00 £70 0 0.00 983 12.67 £78 1,333 17.67 £75
Registered Nursing, Midwifery
and Health visiting staff47,413 1,155.54 42,303 1,072.82 £39 1,069 24.60 £43 1,503 30.91 £49 44,875 1,128.33 £40
Scientific, Therapeutic and
Technical staff - of which Allied
Health Professionals
13,001 305.89 12,532 317.97 £39 136 3.08 £44 29 0.58 £50 12,697 321.63 £39
Support to clinical staff 13,670 503.13 11,296 442.54 £26 2,912 105.27 £28 2,972 89.27 £33 17,180 637.08 £27
Total Clinical 83,843 2,067.32 74,278 1,910.19 £39 4,117 132.95 £31 6,594 139.96 £47 84,989 2,183.10 £39
% of Total 87% 5% 8% 100%
NHS Infrastructure Support 23,514 687.89 23,157 673.75 £34 0 0.00 0 0.00 23,157 673.75 £34
Non Medical/Clinical staff 2,851 91.54 0 0.00 1,433 46.48 £31 210 4.70 £45 1,644 51.18 £32
Total Non Clinical 26,365 779.43 23,157 673.75 £34 1,433 46.48 £31 210 4.70 £45 24,801 724.93 £34
% of Total 93% 6% 1% 100%
Total All Staff 110,208 2,846.75 97,435 2,583.94 £38 5,550 179.43 £31 6,804 144.66 £47 109,790 2,908.03 £38
% of Total 89% 5% 6% 100%
Non
Clinical
Substantive Bank Agency
Clinical
Staff Category
All Staff
14 of 27 Board Integrated Performance Report - February 2018
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
Q23a - Safer Staffing: Inpatient Services
Risks: - Hotspot areas in terms of vacancies (remain in DAU, Thornton, Bracken and Ashbrook)
meaning safe staffing levels cannot be sustained long term without posts being permanently
recruited to. The process of permanent recruitment continues however, with 36 qualified
nursing posts currently being recruited to (33 in pipeline), 27 support worker posts (23 in
pipeline) and 5 OT/ OT Assistant posts (2 in pipeline).
Contingency/ Mitigating Actions:
- Roster review / risk assessment in place on a daily basis
- Weekly ward meetings continue to be held to forward plan rosters and re-distribute staff across
services as required. Redeployment of staff is now recorded in the system to provide audit trail.
- The SafeCare module is currently being piloted on the acute mental health wards with the
Keith Hurst Acuity model. The pilot on DAU using an acuity model developed internally
(aligned to MH Patient Clustering) has been run in September/October; with a paper
comparing the output of both pilots being presented at the next Safer Staffing Group Meeting in
February.
- Full programme of recruitment fayres (including Dublin) being attended in next 12 months.
DAU have inducted 12 volunteers in Sept 2017 and will report on progress with this initiative at
Q&S early in 2018. - Ongoing proactive work with universities to recruit newly qualified nurses, along with a review
of the preceptorship programme, Additional MH nurse training placements (increase to 36)
also available this year.
- The safer staffing steering group is currently undertaking safer staffing reviews with each ward
to look at skill mix possibilities and establishment levels against need of the unit as
recommended by the National Quality Board – Safe, Sustainable and Productive Staffing
document.
Narrative on data extracts regarding staffing levels on
13 wards during January 2018
Exact/over compliant shifts - Over compliant shifts continue to be
monitored across all wards during the weekly planning meetings held within
the services. The hotspots during January were on the Dementia
Assessment Unit (DAU), Clover (PICU), Fern, Heather, Ashbrook, Thornton
and Oakburn wards due to the increase in acuity (complexity of need) and
the requirement for skill mix within the units.
The number of bank or agency shifts requested has been reducing over the
last few months from nearly 4,000 in October 2017 to 2,800 in January
2018). 38% of the shifts in January were requested for Specialing and
Escorting (which equates to an additional 22% over the baseline
requirements to safely staff the wards). Vacancy is the highest request
reason for booking at 47%, (5% increase from December), with hotspot
areas remaining as DAU, Thornton, Bracken and Ashbrook.
Under compliant shifts - There were 45 incidents reported relating to
staffing shortages in January 2018 (an increase of 7 from the previous
month), the majority of these remain in Specialist inpatient services, due to
acuity of need and difficulty in providing cover. Sickness levels decreased
in January (from 12%) with 9% of bank and agency bookings being
attributed to long term sickness. The Trust continues to be part of the NHS
Improvement 90 Day Rapid Improvement Collaboration on eRostering.
The aim of the programme is to collaborate with the cohort of 22 other
trusts to identify efficiency challenges and then apply improvements to
rostering processes over a 90 day cycle. The Trust is focusing on
reviewing roster rules, monitoring and reducing unused contracted hours
and working closely with the wards to initiate cultural changes to ensure
autorostering is optimised across all areas. Medium term actions within the
plan include; roll-out and embedding of the SafeCare module, change from
4 week to 8 week rosters to initiate longer term planning; and modelling
different shift times/ patterns for potential pilot in the new year.
Non-compliant shifts – One shift was identified as being non-compliant in
January. This was on the Assessment & Treatment Unit (ATU) due to no
registered nurse being available on the night shift. This was mitigated by
the Duty Nurse on Low Secure overseeing the night shift.
No. shifts
Exact/ Over Compliance 2115
Under Compliance 196
Non Compliance 1
15 of 27 Board Integrated Performance Report - February 2018
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
Q23a - Safer Staffing: Inpatient Services
Main 2 Specialties on
each ward
Specialty 1
Total
monthly
planned staff
hours
Total
monthly
actual staff
hours
Total
monthly
planned staff
hours
Total
monthly
actual staff
hours
Total
monthly
planned staff
hours
Total
monthly
actual staff
hours
Total
monthly
planned staff
hours
Total monthly
actual staff
hours
Fern710 - ADULT MENTAL
ILLNESS945 1065 915 1125 288.3 455.7 576.6 892.8 112.7% 123.0% 158.1% 154.8%
Heather710 - ADULT MENTAL
ILLNESS1147.5 1102.5 1177.5 1590 288.3 306.9 864.9 1181.1 96.1% 135.0% 106.5% 136.6%
Bracken710 - ADULT MENTAL
ILLNESS937.5 787.5 1387.5 1515 288.3 288.3 864.9 930 84.0% 109.2% 100.0% 107.5%
Ashbrook710 - ADULT MENTAL
ILLNESS930 1072.5 1395 1905 288.3 334.8 864.9 1190.4 115.3% 136.6% 116.1% 137.6%
Maplebeck710 - ADULT MENTAL
ILLNESS967.5 1065 1357.5 1365 288.3 316.2 864.9 892.8 110.1% 100.6% 109.7% 103.2%
Oakburn710 - ADULT MENTAL
ILLNESS937.5 1245 1387.5 1762.5 288.3 344.1 864.9 1199.7 132.8% 127.0% 119.4% 138.7%
Baildon710 - ADULT MENTAL
ILLNESS975 907.5 1117.5 1132.5 288.3 288.3 576.6 576.6 93.1% 101.3% 100.0% 100.0%
Ilkley710 - ADULT MENTAL
ILLNESS742.5 840 1117.5 1147.5 288.3 288.3 576.6 576.6 113.1% 102.7% 100.0% 100.0%
Thornton710 - ADULT MENTAL
ILLNESS1140 1222.5 2115 3540 288.3 306.9 864.9 1934.4 107.2% 167.4% 106.5% 223.7%
Assessment & Treatment
Unit (LD)
700- LEARNING
DISABILITY945 960 1845 2032.5 288.3 288.3 864.9 1329.9 101.6% 110.2% 100.0% 153.8%
Clover (PICU)710 - ADULT MENTAL
ILLNESS855 847.5 1935 2377.5 288.3 316.2 1153.2 1618.2 99.1% 122.9% 109.7% 140.3%
Step Forward (Rehab)710 - ADULT MENTAL
ILLNESS697.5 735 697.5 817.5 288.3 288.3 576.6 567.3 105.4% 117.2% 100.0% 98.4%
Dementia Assessment Unit
(DAU)
710 - ADULT MENTAL
ILLNESS930 1035 2790 4995 576.6 548.7 1441.5 3375.9 111.3% 179.0% 95.2% 234.2%
Fill rate indicator returnStaffing: Nursing, midwifery and care staff
Average fill
rate -
registered
nurses/midwiv
es (%)
Average fill
rate - care
staff (%)
Average fill
rate -
registered
nurses/midwiv
es (%)
Average fill
rate - care
staff (%)
Day Night
Ward name
Registered
midwives/nursesCare Staff
Registered
midwives/nursesCare Staff
Day Night
16 of 27 Board Integrated Performance Report - February 2018
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
Q23b: Staffing Ratio (Trends): Community Services
Recommended Ratio
FNP (Bradford) - ratio for FNP is based on the national licensing agreement.
Health Visitors (Bradford) - based upon nationally recommended levels amended to reflect local needs.
School Nursing (Bradford) - locally developed based upon pupil numbers and numbers of pupils in pre-determined priority support needs
and is reflective of the school nursing staff mix, not just school nurses.
Special Needs School Nursing - does not have a national recommendation, therefore it has been set locally.
Early Intervention in Psychosis (EIP), Assertive Outreach (AOT), Community Mental Health Teams (CMHT) and Child and Adolescent
Mental Health Services (CAMHS) are based on national standards.
Matrons and Case Managers - ratio is based upon Bradford & North Commissioning Alliance Service Delivery Plan.
Red, amber, green thresholds are established by local managers using their professional judgement.
Jan-18Actual this
month
Service Arearecommend
ratio
Ratio of
Cl ients to
s taff
Amber i f
greater
than
Red i f
greater
than
F M A M J J A S O N D J
FNP 25:1 15 25 28
Health Visitors 312:1 337 312 362
School Nursing 2200:1 2686 2200 2500
Special Need School Nursing 75:1 65 85 90
EIP 15:1 18.6 15 18
AOT 15:1 17 15 18
CMHT 35:1 32 33 35
CAMHS 40:1 34.2 35 40
Matrons and Case Managers 70:1 59 77 84
17 of 27 Board Integrated Performance Report - February 2018
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
Q23b: Staffing Ratio Community Services
Deputy Director,
Nursing, Children and Specialist Services
Health Visiting services within Bradford remain as amber
due to high numbers of maternity leaves, in conjunction
with a vacancy freeze as part of securing the savings
identified by the public health reduction in 2018/19. School
Nursing remains in the red due to sickness and maternity
leaves. Work is underway to support staff to return to work
and staff are prioritising safeguarding and more complex
cases . A wider local authority consultation has
commenced concluding in February 2018, highlighting
£13.3 million cost reduction savings across the
partnership. Work is ongoing between BDCFT children’s
managers and the commissioners to agree a revised
service specification in line with these.
Deputy Director
Mental Health Acute and Community
Early Intervention in Psychosis team ratios remain rated
red, due to continued increase in referrals. However
recruitment of 4 posts starting February/March to support
this should start to see improvement in waiting times and
caseloads. CAMHS is maintaining green rating, due to
ongoing work on caseload management and recruitment.
The new CMHT Assessment team in place since
December 2017 will support caseload management within
this service.
Deputy Director
Adults Community Physical Health
Work ongoing to explore safer staffing models for District
Nursing community services. A pilot of 2 teams has been
undertaken and this will be included within the community
dashboard.
Legend / Glossary:
Black line indicates current months ratio of cases to staff against agreed thresholds.
FNP: Family Nurse Partnership
EIP: Early Intervention in Psychosis
AOT: Assertive Outreach Team
CAMHS: Child and Adolescent Mental Health Services
CMHT: Community Mental Health Teams
0 10 20 30
FNP
0 5 10 15 20
EIP
0 100 200 300 400 500
Health Visitors
0 20 40 60 80 100
Special Needs School Nursing
0 20 40 60 80 100 120
Matrons and Case Managers
0 10 20 30 40
CMHT
0 10 20 30 40 50
CAMHS
0 1000 2000 3000
School Nursing
0 5 10 15 20
AOT
18 of 27 Board Integrated Performance Report - February 2018
Q25 – Black and Minority Ethnic (BME) Diversity in Employment
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
Positive
changes in BME
representation
by Agenda for
Change pay
band
16/17 Outturn 16/17 Outturn17/18
Target
Total HeadcountHeadco
untNot Stated White BME % BME
Band 1 62 24.19% 71 9 47 15 21.13%
Band 2 306 26.80% 295 20 194 81 27.46%
Band 3 354 29.10% 389 13 266 110 28.28%
Band 4 257 24.12% 300 3 221 76 25.33%
Band 5 524 22.52% 566 19 422 125 22.08%
Band 6 776 15.85% 838 37 673 128 15.27%
Band 7 280 12.14% 307 8 260 39 12.70%
Band 8a 113 16.81% 118 4 96 18 15.25%
Band 8b 37 2.70% 35 1 33 1 2.86%
Band 8c 12 8.33% 11 1 9 1 9.09%
Band 8d 11 9.09% 10 0 9 1 10.00%
Band 9 0 0.00% 1 0 1 0 0.00%
Exec Team 5 0.00% 5 0 5 0 0.00%
Medical Staff 75 42.67% 80 22 24 34 42.50%
Dental Staff 19 36.84% 18 0 11 7 38.89%
Non-Exec Team 6 16.67% 6 3 3 0 0.00%
Trust Total 2837 21.11% 3050 140 2274 636 20.85%
In Quarter whole staff statistics
35%
19 of 27 Board Integrated Performance Report - February 2018
Q25 - BME Diversity in Employment
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
The overall total of BME staff employed in the Trust shows a slight increase of 0.24% to 20.85% across the Trust. However this reflects an
overall reduction of 0.46% over the last 12 months.
Positive change can be seen across 7 of the 16 band groupings, the most significant within band 4. In terms of recruitment across the last
12 months – 27.05% of new starters are from BME backgrounds. It should be noted however that 12.67% of new starters chose not to
disclose this information. 30.97% of new starters (excluding not stated) are from BME backgrounds, 30.68% of those were recruited to band
2 positions, 13.67% of those were recruited to band 4 positions, and 23.58% of those were recruited to band 5 positions.
Achievement of the 35% target by March 2020 requires a 1.57% increase in BME staff per year. Current data shows a 0.46% reduction over
the last 12 months.
The Trust’s BME in Employment strategy ended in 2017 and the Board ratified a new Equality and Diversity Strategy in January 2018. A
comprehensive action plan is in place to underpin the implementation of the strategy.
In the next quarterly review bank workers will be added into the review.
20 of 27 Board Integrated Performance Report - February 2018
Patient and Service User Experience: Overview by Service Areas
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
The table shows for each service area:
the number of Friends and Family Test
reviews received; the percentage who
would be either likely or extremely
likely to recommend the service (this is
percentage of reviews where a
preference was expressed) and the
‘patient experience’.
The ‘unknown speciality’ is where the
reviewer did not complete the name of
the service/ward.
Reporting Period: Quarter 3, 2017-18 (Oct, Nov, Dec 2017)
Area
Number of reviews
expressing an
opinion
Percentage of
reviewers likely to
recommend service
to friends and family
Trust as a Whole 2424 95%
Acute Wards 141 89%
Adult Mental health 11 100%
Children and Adolescent Mental Health
Services 23 61%
Clinical Admin Services 29 90%
Community Mental Health Teams 69 91%
Community Nursing 169 98%
Dental Services 158 97%
District Wide Specialist Services 69 100%
Family Nurse Partnership Speciality 9 100%
Health Visiting 425 98%
Learning Disabilities 107 100%
Looked after Children 89 93%
Older Peoples Mental Health 76 100%
Palliative Care Speciality 2 100%
Podiatry Speciality 85 95%
Psychological Therapies City Locality 1 100%
School Nursing 791 96%
Specialist Inpatient services 110 83%
Speech and Language Therapy 38 100%
Unknown Specialty 2 100%
Volunteer Services 20 95%
21 of 27 Board Integrated Performance Report - February 2018
Quality Assurance
Indicator
Number Target
Target met this
month Yes/No
Q5 Never Events Yes
Q7 Meet Central Alert System (CAS) timelines Yes
Q10 No MRSA bacteraemia cases Yes
Q11 No Methicillin sensitive staphylococcus aureus (MSSA) bacteraemia cases Yes
Q12 No Clostridium difficile (C.diff) cases Yes
Q32 No Complaints to Information Commissioners Office (ICO) Yes
Q33 No Information Governance Serious Incidents (STEIS) Yes
Q34 Maintain Mixed sex accommodation status Yes
Q35 Meet Dental Referral To Treatment within 52 weeks Yes
Q37 Maintain Publication of the Formulary on Provider’s website Yes
Q38a Meet duty of candour requirement to notify the relevant person of a suspected or actual reportable
patient safety incident Yes
Q38b Number of duty of candour incidents 1
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
22 of 27 Board Integrated Performance Report - February 2018
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
Directors Business & Transformation Programme Monthly Summary
The 2017/18 programme is providing governance and assurance for 8 transformation projects delivering significant service transformation.
The scale of these savings and change activities required is expected to deliver budget reductions totaling £7.973m during 2017/18.
In Month 10 the programme remains red RAG rated but is forecasted to achieve our control total to save £7.973m. We have achieved
£6.154m of savings year to date which is 77% of our target and ahead of plan to date. There is a forecasted shortfall of £498k which is
covered by the £500k high risk reserve put in place at the beginning of the year. There are £740k of savings with either no Quality Impact
delivery plan, or require re-submission. £3.51m of savings have been approved through Quality Panel for 2018-19.
1. Corporate Schemes (not inc Estates) – Currently forecasting to overachieve however non recurrent underspend being used;
work underway to bring forward proposal for changes to Interpreting services
2. Roster Savings – 3 wards piloting either a 2 shift or revised 3 shift system, evaluation planned for March 2018
3. Mental Health Acute & Community – forecast still inclusive of high agency spend, work ongoing to review spend and acuity
as rostering and discharge trackers showing reduction in bank and agency usage.
4. Trust Procurement – Forecasts predicting a £236k shortfall
5. Adult Physical Health - Savings now found recurrently and all schemes Quality Impact Assessed
6. Estates and Facilities - Savings on track and all schemes Quality Impact Assessed
7. Inpatients, Specialist, Dental & Admin – Criteria led Ward Dashboards now live and review of specialing underway
8. Children’s 2017/18 – Both Bradford/Wakefield savings on track and all schemes Quality Impact Assessed
The purpose of Directors Business & Transformation Programme is to ensure effective project governance, delivery, monitor and approve
Project Initiation and risks, issues and exceptions and ensure a consistent approach to Quality Impact Assessments (QIA).
Oct-17 Nov-17 Dec-17 Jan-18
Overall Programme Summary
2018/19 cost
improvement
savings are
being finalised
as part of the
planning work.
A verbal
update will be
provided to the
Board.
23 of 27 Board Integrated Performance Report - February 2018
Finance Key Measures
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
Plan ActualVariance
(Adv)/FavRAG Plan Actual
Variance
(Adv)/FavRAG
Surplus/(Deficit) including Technical Adjustments 441 2,327 1,886 1,578 2,398 820
Add back all I&E impairments/(reversals) (206) (206) (206) (206)
Retain impact of DEL I&E (impairments)/reversals 206 206
Control Total Performance 441 2,120 1,679 1,578 2,398 820
Additional STF Finance Incentive income 0 410 410
Profit on Disposal of Fixed Assets 203 203 203 203
Impairment reversal 206 206
Surplus/(Deficit) excluding Technical Adjustments 441 1,917 1,476 1,578 1,578 0
CIPs (before High Risk Reserve) 6,275 6,154 (121) 7,973 7,475 (498)
Capital Expenditure 2,921 2,668 253 3,528 3,528 0
Cash Balance 12,013 17,449 5,436 11,485 14,500 3,015
Use of Resources 1 1 0 1 1 0
Forecast Outturn
£000's
Year to Date
Favourable variance
Adverse variance under £100k or 10%
Adverse variance £100k or 10% or greater
Note for RAG for CIPs – 10% variance is Amber, over 10% is Red
Before taking into account the high risk CIP reserve performance is £121k behind plan. A key focus remains
recurrent scheme delivery and/or substitution and is subject to FBIC scrutiny.
24 of 27 Board Integrated Performance Report - February 2018
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
0
100
200
300
400
500
600
700
800
900
1,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
YT
D P
lan &
A
ctu
al
-£
00
0's
In M
onth
P
lan &
Actu
al
-£
00
0's
Cost Improvement Programmes
In Month Plan In Month Actual YTD Actual YTD Plan
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
0
100
200
300
400
500
600
700
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
YT
D P
lan &
Actu
al
-£
00
0's
In M
onth
P
lan &
Actu
al
-£
00
0's
Capital Expenditure
In Month Plan In Month Actual YTD Actual YTD Plan
8,000
9,000
10,000
11,000
12,000
13,000
14,000
15,000
16,000
17,000
18,000
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
In Month Cash Balances
Plan Actual 2016/17
(2,000)
(1,500)
(1,000)
(500)
0
500
1,000
1,500
2,000
2,500
3,000
(800)
(600)
(400)
(200)
0
200
400
600
800
1,000
1,200
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Ye
ar to
Da
te P
lan a
& A
ctu
al
-£
00
0's
In M
onth
P
lan &
Actu
al
-£
00
0's
Control Total Performance
In Month Plan In Month Actual YTD Plan YTD Actual
-
1
2
3
4
Q1 Q2 Q3 Q4
Quarterly Use of Resources
Plan Actual
Workforce KPIs - Agency Expenditure Cap
(Adv)/Fav
Variance
from Cap
£000's
RAGChange in
month
Total Agency Expenditure Cap in Month 61 Improvement
Medical Agency Expenditure Cap in Month (30) Improvement
Workforce KPIs - Agency Expenditure Cap
(Adv)/Fav
Variance
from Cap %
RAGChange in
month
Qualified Nursing Expenditure Cap - In Month 0.93% Improvement
Qualified Nursing Expenditure Cap - YTD 1.24% Deterioration
Workforce KPIs - Price & Wage Cap BreachesNo. of
ShiftsRAG
Change in
month
Price Cap Breaches in Month - Medical 207Increase due
to 5 week
Wage Cap Breaches in Month - Medical 210Increase due
to 5 week
Price Cap Breaches in Month - Non Medical 0 No change
Wage Cap Breaches in Month - Non Medical 0 No change
Workforce KPIs - Average cost per WTE £000's RAGChange in
month
Average cost per WTE 38 No change
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
25 of 27 Board Integrated Performance Report - February 2018
Trust CIP Exceptions and Substitutions
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
Reason for Variance & Mitigating Actions
CIPs have under achieved by £121k YTD and forecast to under achieve by £498k (before high risk reserve). The recurrent CIP gap that
will be brought forward into 2018/19 is £70k.
The forecast reflects projected shortfalls against a number of schemes, including:
• Agency and Skill Mix schemes in Specialist Inpatient and Mental Health services are reporting a further shortfall in delivery mainly due
to cover required for sickness, vacancies and high level of in year observation costs associated with patient acuity
• Roster plans that have been paused. Activities linked to a 90 day NHSI improvement programme are scheduled in the final quarter to
support the Trust to scope and test roster changes. Roster savings have been removed from the 2018/19 plan with the exception of
£50k savings attributable to Acute Mental Health wards
• Procurement stretch target – the prudent forecast risk reflects run rate efficiencies however the procurement team is focused on
identifying opportunities to fully achieve including use of national Procurement Price Index Benchmarking (PPIB) data now accessible to
community and Mental Health Trusts through a licence with NHS Improvement
• Human Resources slippage on structure savings in year, which will be delivered in full from 2018/19
• Interpreting savings from telephone sessions have been eroded as a result of increased service volume
Variance Variance
(Adv)/Fav (Adv)/Fav
Green 5,828 4,995 (833) 7,234 6,115 (1,118)
Amber 84 57 (27) 233 72 (161)
Red/Blue 363 0 (363) 507 0 (507)
Mitigations 0 1,102 1,102 0 1,288 1,288
Total CIPs 6,275 6,154 (121) 7,973 7,475 (498)
High Risk Reserves (500) 0 500 (500) 0 500
Total CIPs net of Reserves 5,775 6,154 379 7,473 7,475 2
QIA RAG Status
Year to Date - £000's Forecast Outturn - £000's
Plan Actual Plan Actual
26 of 27 Board Integrated Performance Report - February 2018
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
Assurance Reports from Committee Chairs
Assurance Report: Quality and Safety Committee – 9 February 2018
Assurances
• Children’s services strategy: the committee was assured that the strategy engaged extensively with service users to design a model of
care with the child at the centre of the service network, recognising that others may be appropriately involved in the decision about what
is best for a child. In light of the uncertainties surrounding the children’s service model going forward, including severe financial
pressures, the committee asked to receive an update on implementation of the strategy later in the year.
• Serious Incident policy: following review the policy was approved by the committee. The committee welcomed the review of the
network of clinical policies within which this policy sits.
• Safeguarding children - Wakefield: the committee was assured that the risks present at the point of transfer of the service have been
mitigated with a safeguarding team and supervision in place and a significant improvement in proportion of staff with in date
safeguarding training, operating to a single set of standards across the Trust.
• Business Units: the committee was assured of an ongoing robust approach to quality and safety assurance and improvement in the
Adult Mental Health and Specialist Inpatient, Administration and Dental Services.
• BDCFT currently has the highest achievement nationally on the CQUIN Physical Review of the health of Mental Health service
users.
• There has been an external review of the Forensic Mental Health service with 7 of 14 standards met and areas of good practice
noted, 3 partly met and 4 not met.
• Out of Hospital Care: the committee received an assurance report on the development of an integrated approach across the Bradford
Integrated Care System including the establishment of Primary Care Homes to include GPs, BDCFT, acute Trust, local authority
community services and voluntary services
• Dashboard: a slide showing achievement of required training is now included in the dashboard
• All call monitoring KPIs for the Single Point of Access were rated green in December for the first time (data is collected monthly).
Exceptions
• Business Unit red risks:
- Vacancies in psychological therapies for service users with Learning Disabilities - two of the posts are expected to be filled shortly
- The transfer of calls from the SPA to First Response: two of four tele-coach posts have been filled; there now only isolated
instances of long waiting times for calls to be answered and the number of unsuccessful transfers has fallen.
- Staffing on the Dementia Assessment Unit continues to be challenging despite a range of actions in place.
• Dashboard: despite all actions taken waiting lists for ccommunity mental health psychology services continue to grow.
• The number of clinical policies in date has deteriorated with a quarter of policies out of date and no smart plan for approval in place. A
strengthened monitoring process has been agreed
• The committee agreed to the development of a new provider Serious Incident Assurance report, incorporating the work of the
refreshed Serious Incident and Complaints forum as well as the relevant elements of the CQC action plan, to give assurance of
appropriate and sustained learning from Serious Incidents.
27 of 27 Board Integrated Performance Report - February 2018
Summary NHS
Improvement Quality
Business Unit
Change Programme
Finance Enablers
Well Led
Assurance Reports from Committee Chairs
Assurance Reports: Audit Committee and Finance, Business and Investment Committee
• Audit Committee, 19 February 2018 – a paper will be tabled at the Board meeting
• Finance, Business and Investment Committee – next meeting March 2018